The Medical journal of Australia
-
This case report illustrates the threat to life posed by tiger snake venom-induced coagulopathy, the importance of first-aid, precautions with antivenom administration, the dose of antivenom and the necessity to monitor the coagulation status. ⋯ More public education is required in first-aid management of snake envenomation. Frequent monitoring of coagulation status is necessary to optimise antivenom and coagulation factor therapy.
-
We report a study of 347 patients with snake bite envenomation in Papua New Guinea. The male: female ratio of the victims was 1.6:1 and their mean age was 24.5 years; 26% were children less than 15 years old. In all cases in which the bite site was known (334) the snake had bitten the extremities of the victim, with 71.3% of these bites being on the ankle or below. ⋯ However, increased relative numbers of taipans seem to be occurring in central Papua possibly related to the cane toad (Bufo marinus) and deforestation. We calculate the annual incidence of envenomation and the mortality rate per 100,000 to be 81.8 and 4.3, respectively, for rural central Papua, 21.8 and 2.1 for urban central Papua, and 3.0 and less than 1.0 for the Madang region of New Guinea. The importance of a standard management protocol and of improved first aid are emphasised.
-
As a result of a desire amongst the hospital staff to improve the management of dying children and their families, a four person subcommittee was appointed to investigate this area of care. Nineteen persons were interviewed (15 hospital staff members and four parents) and 12 written submissions were received (10 from staff and two from parents) over a 10 week period. An analysis of one year's deaths of Adelaide Children's Hospital patients showed that most took place in the hospital and about one in five were at home. ⋯ More awareness of the availability of the specialised pain relief service was required. Ethical issues should be addressed as part of the general development of education and information services. The advantages and limitations of the enquiry are discussed and the model is proposed as a potentially useful one for both paediatric and adult palliative care and hospice care service development.